Young Africans Suffering Advanced HIV Disease From Delayed Diagnosis

[Guest guest]

Young Africans Suffering Advanced HIV Disease From Delayed Diagnosis

13 Feb 2007

A new study suggests the effects of long-standing, undiagnosed HIV

infection are hanging over a generation of adolescents in Zimbabwe,

causing organ damage, chronic ill health, stunted growth, and other

problems. The research demonstrates the need to reduce barriers to

early testing and admission to care for these adolescents. It

appears in the March 15 issue of Clinical Infectious Diseases,

currently available online.

" We suspect that there is a substantial and growing burden of long-

standing HIV infection and AIDS in this age group, " said lead author

Rashida Ferrand, MBBS, MRCP, DTMH, " especially in countries where

HIV prevalence in pregnant women has been high for over ten years -

giving time for survivors of mother-to-child transmission to grow

up. " She and her colleagues from London and Zimbabwe have recently

completed a study of 32 adolescents from the Connaught Clinic in

Harare, Zimbabwe.

Because of the difficulties and expense of obtaining HIV testing and

care, the average delay between the first serious illness to HIV

diagnosis was 3.5 years, despite the fact that 75 percent of the

parents or guardians suspected HIV infection. By the time they

sought care, many of the patients had long histories of the types of

ill health that suggest HIV infection, including chronic skin,

respiratory, and gastrointestinal symptoms. In addition, many of the

patients' health care providers must have considered the possibility

of an HIV diagnosis, as more than 40 percent of the participants had

taken cotrimoxazole, an antibiotic which the World Health

Organization recommends be given to HIV-infected children to prevent

pneumocystis pneumonia and other infections.

" A delayed diagnosis means that patients present late in the course

of HIV infection, " said Dr. Ferrand, " by which time they may already

have significant and irreversible damage to vital organs such as the

heart and lungs, plus an increased risk of serious opportunistic

infections with high mortality. " These infections are preventable

with antiretroviral therapy (ART) and cotrimoxazole.

Earlier diagnosis of HIV infection is paramount, as there is a

higher risk of death and disease progression in patients who delay

starting treatment until they have advanced disease. Earlier

treatment is also crucial. Previous studies show treatment is less

effective if started in patients who have advanced disease. The

opportunity for " catch-up " growth on ART may be lost if it is

delayed until late adolescence.

" What we are looking at here are the consequences of not having

programs to prevent maternal-to-child transmission of HIV in the

1990s, " said Dr. Ferrand. " We need to deal with these children who

have already suffered terribly from the indirect effects of HIV:

orphanhood, impoverishment, and the psychological trauma of

prolonged illness in parents and siblings. More research into the

scope of the problem of late-childhood HIV/AIDS and the problems

faced so stoically by these vulnerable and ignored group of

patients -- medical, socio-economic, and psychosocial -- will help

in the development of policy and practice. And we need to strengthen

programs to prevent maternal-to-child transmission so that we can

prevent this problem in the future. "

###

Founded in 1979, Clinical Infectious Diseases publishes clinical

articles twice monthly in a variety of areas of infectious disease,

and is one of the most highly regarded journals in this specialty.

It is published under the auspices of the Infectious Diseases

Society of America (IDSA). Based in andria, Virginia, IDSA is a

professional society representing more than 8,300 physicians and

scientists who specialize in infectious diseases. Nested within the

IDSA, the HIV Medicine Association (HIVMA) is the professional home

for more than 3,500 physicians, scientists and other health care

professionals dedicated to the field of HIV/AIDS. HIVMA promotes

quality in HIV care and advocates policies that ensure a

comprehensive and humane response to the AIDS pandemic informed by

science and social justice. For more information, visit

http://www.idsociety.org/ and http://www.hivma.org/.

Contact: Steve Baragona

Infectious Diseases Society of America

[Guest guest]

Young Africans Suffering Advanced HIV Disease From Delayed Diagnosis

13 Feb 2007

A new study suggests the effects of long-standing, undiagnosed HIV

infection are hanging over a generation of adolescents in Zimbabwe,

causing organ damage, chronic ill health, stunted growth, and other

problems. The research demonstrates the need to reduce barriers to

early testing and admission to care for these adolescents. It

appears in the March 15 issue of Clinical Infectious Diseases,

currently available online.

" We suspect that there is a substantial and growing burden of long-

standing HIV infection and AIDS in this age group, " said lead author

Rashida Ferrand, MBBS, MRCP, DTMH, " especially in countries where

HIV prevalence in pregnant women has been high for over ten years -

giving time for survivors of mother-to-child transmission to grow

up. " She and her colleagues from London and Zimbabwe have recently

completed a study of 32 adolescents from the Connaught Clinic in

Harare, Zimbabwe.

Because of the difficulties and expense of obtaining HIV testing and

care, the average delay between the first serious illness to HIV

diagnosis was 3.5 years, despite the fact that 75 percent of the

parents or guardians suspected HIV infection. By the time they

sought care, many of the patients had long histories of the types of

ill health that suggest HIV infection, including chronic skin,

respiratory, and gastrointestinal symptoms. In addition, many of the

patients' health care providers must have considered the possibility

of an HIV diagnosis, as more than 40 percent of the participants had

taken cotrimoxazole, an antibiotic which the World Health

Organization recommends be given to HIV-infected children to prevent

pneumocystis pneumonia and other infections.

" A delayed diagnosis means that patients present late in the course

of HIV infection, " said Dr. Ferrand, " by which time they may already

have significant and irreversible damage to vital organs such as the

heart and lungs, plus an increased risk of serious opportunistic

infections with high mortality. " These infections are preventable

with antiretroviral therapy (ART) and cotrimoxazole.

Earlier diagnosis of HIV infection is paramount, as there is a

higher risk of death and disease progression in patients who delay

starting treatment until they have advanced disease. Earlier

treatment is also crucial. Previous studies show treatment is less

effective if started in patients who have advanced disease. The

opportunity for " catch-up " growth on ART may be lost if it is

delayed until late adolescence.

" What we are looking at here are the consequences of not having

programs to prevent maternal-to-child transmission of HIV in the

1990s, " said Dr. Ferrand. " We need to deal with these children who

have already suffered terribly from the indirect effects of HIV:

orphanhood, impoverishment, and the psychological trauma of

prolonged illness in parents and siblings. More research into the

scope of the problem of late-childhood HIV/AIDS and the problems

faced so stoically by these vulnerable and ignored group of

patients -- medical, socio-economic, and psychosocial -- will help

in the development of policy and practice. And we need to strengthen

programs to prevent maternal-to-child transmission so that we can

prevent this problem in the future. "

###

Founded in 1979, Clinical Infectious Diseases publishes clinical

articles twice monthly in a variety of areas of infectious disease,

and is one of the most highly regarded journals in this specialty.

It is published under the auspices of the Infectious Diseases

Society of America (IDSA). Based in andria, Virginia, IDSA is a

professional society representing more than 8,300 physicians and

scientists who specialize in infectious diseases. Nested within the

IDSA, the HIV Medicine Association (HIVMA) is the professional home

for more than 3,500 physicians, scientists and other health care

professionals dedicated to the field of HIV/AIDS. HIVMA promotes

quality in HIV care and advocates policies that ensure a

comprehensive and humane response to the AIDS pandemic informed by

science and social justice. For more information, visit

http://www.idsociety.org/ and http://www.hivma.org/.

Contact: Steve Baragona

Infectious Diseases Society of America